Pediatrics Question #18


Which of the four pediatric patients in the emergency department should the nurse make a
priority for diagnostic testing?


  1. A 1-year-old with a ventriculoperitoneal shunt who is difficult to arouse and has a 72/min pulse.
    • Rationale:
  2. A 4-year-old with spina bifida occulta who has experienced several episodes of urinary incontinence.
    • Rationale:
  3. A 5-year-old with muscular dystrophy who has “flu-like” symptoms and a low grade fever.
    • Rationale:
  4. A 7-year-old with cerebral palsy with a new leg injury and is having spasticity in the area of the injury.
    • Rationale:



The correct answer is A. A ventriculoperitoneal shunt is used to relieve pressure on the brain by hydrocephalus. If the shunt is not properly working, complications can arise. An infant who is difficult to arouse and has an abnormal low pulse would be a priority. Urinary incontinence can occur in a child with spina bifida occulta. The inability to control bowel and bladder discharge resulting in involuntary loss of urine (urinary incontinence) or feces (fecal incontinence). The brain is unable to control the muscles that coordinate bladder and bowel function. This is an expected finding and not an immediate priority. A low grade fever is not an immediate concern. The flu-like symptoms should be further assessed but is not the priority patient. It is normal for a child with cerebral palsy to have spasticity in the lower limbs. The new leg injury should be further assessed but is not the priority.

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